NCCN Updates Ovarian Cancer Clinical Practice Guidelines
The National Comprehensive Cancer Network (NCCN) has updated their guidelines for the treatment of ovarian cancer, including therapy for stage II-IV disease and persistent disease.
Added to the list of tumor markers to be tested as clinically indicated during the workup for ovarian cancer is CA 19-9.
For stage II-IV, post primary treatment, bevacizumab has been added as a maintenance therapy options if partial or complete remission is observed following systemic therapy with bevacizumab. Pazopanib has been changed to a category 3 maintenance therapy option if complete clinical remission is observed following primary therapy for patients that did not previously receive bevacizumab. Paclitaxel has been removed from the maintenance therapy options if complete clinical remission is observed following primary therapy for patients that did not previously receive bevacizumab.
Multiple changes have been made to the section “Therapy for Persistent Disease or Recurrence.” After complete remission and relapse of at least 6 months following prior chemotherapy, continuation of bevacizumab has been added as a maintenance therapy option for patients with a partial or complete response following platinum-based recurrence chemotherapy with bevacizumab. In the same setting, rucaparib has been added as a maintenance therapy option for patients with a partial or complete response following two or more lines of platinum-based therapy.
For mucinous carcinoma, 5-FU plus leucovorin, oxaliplatin, and bevacizumab has been added as a category 2B adjuvant therapy option for stage II-IV disease. Similarly, capecitabine plus oxaliplatin and bevacizumab has been added as a category 2B adjuvant therapy option for stage II-IV disease.
Multiple category 2B recommendations were added to the low-grade serous/grade I endometrioid epithelial carcinoma section: exemestane for stage IC-IV disease and maintenance hormonal therapy following chemotherapy for stage II-IV disease.
Among the primary systemic therapy options added for stage I epithelial ovarian cancer include:
· Paclitaxel 175 mg/m2 IV over 3 hours followed by carboplatin AUC 5–6 IV over 1 hour Day 1. Repeat every 3 weeks x 3–6 cycles. (preferred)
· Carboplatin AUC 5 + pegylated liposomal doxorubicin 30 mg/m2 every 4 weeks for 3–6 cycles
· Docetaxel 60–75 mg/m2 IV over 1 hour followed by carboplatin AUC 5–6 IV over 1 hour Day 1. Repeat every 3 weeks x 6 cycles
A few regimens have been changed to category 2A recommendations for stage II-IV epithelial disease, including IP/IV paclitaxel/cisplatin; IV paclitaxel/carboplatin (weekly); IV dose-dense paclitaxel/carboplatin; IV paclitaxel/carboplatin (every 3 weeks); and IV docetaxel/carboplatin.—Zachary Bessette